Extended articular surface resurfacing head

ABSTRACT

A modular humeral head resurfacing implant including a head, an anchoring stem, and a modular extended articulation flange. The head includes an exterior hemispherical articulating surface defining a terminating rim, an interior concave surface opposite to the exterior articulating surface, and a first coupling mechanism proximate to the terminating rim. The anchoring stem is coupled to the interior concave surface and extends along a stem axis that extends through an axial center of the head. The articulation flange includes a second coupling mechanism configured to cooperate with the first coupling mechanism to fasten the articulation flange to the head and an outer articulating surface that is curved along substantially its entire length and is substantially flush with the exterior hemispherical articulating surface when the articulation flange is fastened to the head.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional application of U.S. patent applicationSer. No. 12/696,516 filed on Jan. 29, 2012, which is a continuationapplication of U.S. patent application Ser. No. 11/258,341 filed on Oct.25, 2005, which is a continuation-in-part application of U.S. patentapplication Ser. No. 10/669,971 filed on Sep. 24, 2003. The disclosuresof the above applications are incorporated herein by reference.

FIELD OF THE INVENTION

The present invention relates to prosthetic implants. In particular, thepresent invention relates to a humeral resurfacing implant.

BACKGROUND OF THE INVENTION

The humerus is the longest and largest bone of the human upperextremity. It is divisible into a body and two extremities. The upperextremity comprises a head that is joined to the body by a constrictedportion generally called the neck. The head is nearly hemispherical inform and articulates with the glenoid cavity of the scapula or shoulderblade. The humerus is secured to the scapula by the rotator cuff musclesand tendons.

It is not uncommon for the exterior surface of the humeral head to bedamaged or defective. Conventionally, a variety of humeral headresurfacing implants exist for repairing humeral head surfaces. Whileconventional humeral head resurfacing implants are suitable for theirintended uses, such implants are subject to improvement.

Conventional humeral head resurfacing implants fail to accommodatepatients having inadequate rotator cuff muscles. Specifically,conventional implants do not permit articulation between the implant andthe concave undersurface of the coracoacromial arch of the scapula, thecoracoacromial arch being a structural component of the shouldercomprising the coracoacromial ligament, coracoid process, and acromion.Thus, there is a need for a humeral head resurfacing implant thatpermits articulation with the coracoacromial arch in patients havinginadequate rotator cuff muscles.

SUMMARY OF THE INVENTION

The present teachings provide for a modular humeral head resurfacingimplant including a head, an anchoring stem, and a modular extendedarticulation flange. The head includes an exterior hemisphericalarticulating surface defining a terminating rim, an interior concavesurface opposite to the exterior articulating surface, and a firstcoupling mechanism proximate to the terminating rim. The anchoring stemis coupled to the interior concave surface and extends along a stem axisthat extends through an axial center of the head. The modular extendedarticulation flange protrudes from only a portion of the head whenfastened thereto and is operable to articulate with at least one of abone and a ligament. The articulation flange includes a second couplingmechanism configured to cooperate with the first coupling mechanism tofasten the articulation flange to the head and an outer articulatingsurface that is curved along substantially its entire length and issubstantially flush with the exterior hemispherical articulating surfacewhen the articulation flange is fastened to the head.

The present teachings also provide for a humeral head resurfacingimplant including a head, an anchoring stem, and a modular extendedarticulating flange. The head includes an exterior hemisphericalarticulating surface defining a terminating rim. The terminating rimdefines a rim plane extending from a first side of the terminating rimto a second side of the terminating rim. The head also includes aninterior concave surface opposite to the exterior articulating surfaceand a first coupling mechanism proximate to the terminating rim. Theanchoring stem is coupled to the interior concave surface and extendsalong a stem axis that extends through an axial center of the head andthrough the rim plane, the stem axis is perpendicular to the rim plane.The modular extended articulating flange protrudes from only a portionof the head and extends across the rim plane when fastened to the head.The articulating flange includes a second coupling mechanism that iscoupled to the first coupling mechanism to fasten the articulatingflange to the head.

The present teachings also provide for a method of resurfacing a humeralhead of an implant site. The method includes the following: resurfacingthe humeral head so as to form a generally spherical surface; selectinga modular extended articulation flange having a first coupling mechanismfrom a plurality of modular extended articulation flanges of differentsizes; attaching the first coupling mechanism of the modular extendedarticulation flange to a second coupling mechanism proximate to aterminating rim of a resurfacing humeral head implant including anexterior hemispherical articulating surface defining the terminating rimand an interior concave surface opposite to the exterior articulatingsurface; and positioning the resurfacing humeral head implant on theresurfaced surface of the humeral head.

Further areas of applicability of the present invention will becomeapparent from the detailed description provided hereinafter. It shouldbe understood that the detailed description and specific examples, whileindicating the preferred embodiment of the invention, are intended forpurposes of illustration only and are not intended to limit the scope ofthe invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will become more fully understood from thedetailed description and the accompanying drawings, wherein:

FIG. 1 is a perspective view of an implant according to the presentinvention;

FIG. 2 is bottom view of the implant of FIG. 1;

FIG. 3A is a cross-sectional view taken along line 3-3 of FIG. 2;

FIG. 3B is a cross-sectional side view of the implant of the presentinvention according to an additional embodiment;

FIG. 4 is a perspective view of a typical implantation site prepared toreceive the implant of FIG. 1;

FIG. 5 is a perspective view of the implant of FIG. 1 implanted at theimplantation site of FIG. 4;

FIG. 6 represents a monolithic implant according to an embodiment of theinvention;

FIGS. 7A-7D represent a modular prosthetic head;

FIGS. 8A-8D represent an alternate modular prosthetic;

FIGS. 9 and 10 represent an alternate modular prosthetic utilizing asnap-ring fixation mechanism;

FIG. 11 represents a tool for use to implant the prosthesis shown inFIGS. 7A-10; and

FIGS. 12-22 represent the preparation of a humerus to accept the implantshown in FIGS. 7A-10.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The following description of the preferred embodiments is merelyexemplary in nature and is in no way intended to limit the invention,its application, or uses.

With initial reference to FIGS. 1 through 3, a resurfacing implantaccording to the present invention is illustrated and identified atreference numeral 10. The implant 10 is typically divided into, asillustrated in FIG. 3, a lateral region A and a medial region B, whichis in relation to the implant position in the patient. The implant 10generally includes a resurfacing head 12, an anchoring device or stem14, and an extended surface 16. The extended surface 16 may be locatedin the lateral region A, as illustrated, or at any other position abouta periphery of the head 12. The head 12 includes an exterior surface 18and an interior surface 20 opposite the exterior surface 18. Theexterior surface 18 is generally convex, or dome-shaped, and smooth. Theinterior surface 20 is generally concave.

The interior surface 20 is also generally dome-shaped and substantiallymirrors the exterior surface 18. The interior surface 20 is generallyconcave. The interior surface 20 may be smooth or may include features,such as pores or coatings that facilitate bonding of the interiorsurface 20 to a resurfaced implant site. The interior surface 20 may bebonded to the implant site with or without bone cement. The interiorsurface 20 optionally terminates at an annular rim 24.

The stem 14 extends from the interior surface 20. The stem 14 mayoptionally be tapered such that the diameter of the stem 14 is at itsgreatest at the interior surface 20. To facilitate cooperation betweenthe stem 14 and the implant site, the stem 14 may optionally include oneor more details, such as flutes 26. In addition to or in place of flutes26, the stem 14 may include surface features, such as pores or coatings,to enhance the creation of a bond between the stem 14 and the implantsite.

In some applications, the extended surface 16 is located in the lateralregion A to engage a surface or bone, such as at least one portion ofthe coracoacromial arch. However, the extended surface 16 may be locatedat any other position about the rim 24 to engage a variety of differentbones and/or ligaments. The extended surface 16 is generally comprisedof an outer surface 28, a base surface 30, and an inner surface 32. Theouter surface 28 is typically a continuation of the exterior surface 18.The outer surface 28 may be of any suitable shape or configuration,however, in many instances, the outer surface 28 is curved or rounded tofollow the general shape of the exterior surface 18. The outer surface28 extends about a portion, but less than an entirety of the annular rim24. The extended surface 16 generally extends beyond an equator of thehemispherical head 12, which is generally defined by the rim 24. As seenin FIG. 3A, the extended surface 16 extends from the head 12 in a planarand/or cylindrical manner.

The base surface 30 generally extends from the outer surface 28 towardthe stem 14 at approximately a right angle to the outer surface 28. Thebase surface 30 may be generally planar or may include various surfacefeatures to enhance interaction between the base surface 30 and theimplantation site. The base surface 30 is typically shaped toaccommodate the curvature of the annular rim 24. The length of the basesurface 30 determines, in part, the width of the extended surface 16.

The inner surface 32 extends from the base surface 30 toward theinterior surface 20. The inner surface 32 extends from the base surface30 at an approximate right angle to the base surface 30. The innersurface 32 may be of any suitable shape but is typically shaped togenerally accommodate the curvature of the annular rim 24. In someapplications, the inner surface 32 may be wedged shaped, typically inthe shape of a “V”, to generally facilitate interaction between theimplant 10 and the implantation site by providing a surface that matchesthe shape of a prepared bone that is to receive the implant 10. Theshape of the inner surface 32, such as the wedge shape, may be used toact as a further aide to maintain the implant 10 in its desired positionand prevent rotation of the implant 10 at the implantation site.

If the extended surface 16 is of a relatively small width, the innersurface 32 may be an extension of the interior surface 20 (FIG. 3A). Asillustrated in FIG. 3B, if the extended surface 16 is of a relativelylarge width, the inner surface 32 is not a continuation of the interiorsurface 20, but is connected to the interior surface 20 by an uppersurface 34. The upper surface 34 runs generally parallel to the basesurface 30 and may be, for example, planar or curved. The upper surface34 forms a step on the extended surface 16.

The implant 10 may be made of any suitable biocompatible material, butis typically made from a metal such as cobalt chrome or titanium. Theinterior surface 20 may be coated with a suitable material, such astitanium plasma spray or hydroxyapatite, to enhance the adhesion of theinterior surface 20 to the implantation site or to enhance theeffectiveness of any material, such as bone cement, that may be used toaffix the interior surface 20 to the implantation site. The stem 14 mayoptionally be provided with a blasted finish, with or withouthydroxyapatite, or a micro-bond finish, with or without hydroxyapatite.As a further option, bone cement may be used as an aide to retain theimplant 10 in position.

The implant 10 may be of various different sizes and dimensionsdepending on the sizes and dimensions of the implant site. For example,to accommodate patients having large humeral heads, the implant 10 maybe of a greater overall size than that required to accommodate patientshaving smaller humeral heads. Further, the shape of the exterior surface18 may be customized to insure proper articulation at the implant site.Implants 10 of various different shapes and sizes may be packagedtogether and sold in a single kit.

With reference to FIGS. 4 and 5, the implantation and operation of theimplant 10 will be described in detail. While the implant 10 isgenerally described as a humeral head resurfacing implant, it must benoted that the implant 10 may be used in a variety of differentapplications. The implantation site generally includes a humerus 36 anda shoulder blade or scapula 38. The humerus 36 is generally comprised ofa head 40, a neck 42, and a stem 44. The scapula 38 is generallycomprised of a glenoid cavity 46 that receives the head 40, acoracoacromial arch 48, and a coracoid process 50.

To receive the implant 10, a portion of the exterior surface of thehumeral head 40 is resurfaced and/or removed to accommodate theresurfacing head 12 of the implant 10 such that, when implanted, theimplant head 12 does not generally increase the overall dimensions ofthe humeral head 40. The head 12 is further resected at 52 toaccommodate the extended surface 16. This resection at 52 may beperformed with or without the use of a resection jig. To minimize boneloss, the resection at 52 often takes the shape of a “V”, however, theresection 52 may be of various other shapes or configurations. The “V”shape may also prevent rotation of the head 12, even though theinteraction between the stem 14 and the implant site is more thanadequate to secure the head 12 into position.

To receive the stem 14, which is generally referred to as a short stem14, a peg hole 54 is formed within the head 40 using conventionalinstruments and techniques. The hole 54 is formed with dimensionssubstantially similar to the dimensions of the stem 14 and is positionedsuch that when the stem 14 is seated within the hole 54, the exteriorsurface 18 closely approximates the outer surface of the humeral head40. The hole 54 extends generally only through a portion of the humeralhead 40 and does not necessarily extend to the stem 44 or within theintramedullary canal of the humerus. To ensure proper placement of theimplant 10, a trial implant (not shown) may be positioned at theimplantation site before the implant 10 is implanted.

The trial implant is substantially similar to the implant 10. A stem ofthe trial implant is placed within the hole 54 and the shoulder joint isreduced. If necessary, the head 40 is reamed to better approximate thesize and shape of the interior surface 20. After the proper position ofthe trial implant is noted, the trial is removed and the stem 14 of theimplant 10 is seated within the hole 54. The implant 10 is thenpositioned such that it is in substantially the same position as thetrial implant. The particular size of the implant 10 is chosen accordingto the size and dimensions of the patient's humeral head 40 and scapula38. It must be noted that typically the stem 14 only extends through aportion of the head 40 and does not enter, or replace, the natural stem44 of the humerus 36.

As illustrated in FIG. 5, the implant 10 is orientated at the humeralhead 40 such that the extended surface 16 is positioned at or near thecoracoacromial arch 48. The extended surface 16 may either abut, orclosely abut, the coracoacromial arch 48. When the patient's rotatorcuff muscles are inadequate, the extended surface 16 typically contactsthe coracoacromial arch to provide metal on bone articulation with thecoracoacromial arch 48. However, the extended surface 16 may be rotatedto any other position to engage other bones, ligaments, or surfacesother than, or in addition to, the coracoacromial arch 48.

While interaction between the stem 14 and the hole 54 is typicallysuitable to secure the implant 10 within the hole 54, the stem 14 mayoptionally be secured within the hole 54 using a suitable adhesive, suchas bone cement 56. The optional bone cement 56 may be inserted withinthe hole 54, typically before the implant 10 is placed within the hole54. The flutes 26 of the stem 14 assist in forming a cement mantlebetween the stem 14 and the hole 54 to receive the bone cement 56. Theoptional tapered configuration and blasted finish of stem 14 furtherenhances the bond between the implant 10 and the head 40 by providing amechanical interface. To still further secure the implant 10 to the head40, a suitable adhesive, such as bone cement, may be placed between theinterior surface 20 and the head 40 and various coatings may be appliedto the interior surface 20, such as titanium plasma, to create a bondbetween the interior surface 20 and the head 40.

With the implant 10 in place upon the humeral head 40, patients withinadequate rotator cuff muscles are provided with a device that permitsarticulation between the humerus 36 and the coracoacromial arch 48. Thisarticulation between the humerus 36 and the coracoacromial arch 48enhances range of motion in the patient's shoulder and reduces patientdiscomfort.

FIG. 6 represents a monolithic resurfacing implant according to theteachings of an alternate embodiment. The implant 60 includes aresurfacing head 62, an anchoring device or stem 64 and an extendedbearing member 66. The head 62 has a generally spherical articulatingbearing surface 68 and an interior coupling surface 70.

The stem 64 is coupled to the interior surface 70 and can have varioussurface features 72 to facilitate the coupling of the implant to aresected humerus. Disposed between the articulating surface 68 and theinternal surface 70 of the implant 60 is a base surface 71. The basesurface 71 is congruent with the base surface 73 of the bearing member66. The internal surface 70 defines a generally spherical surface 74,which seats against a resected spherical bearing surface 76 of thehumerus. Additionally, the interior surface 70 defines three flatintersecting surfaces 78A-C. Optionally, the surfaces 78A and Bintersect with surface 78C at obtuse angles. The surfaces 78A-C aresupported by the corresponding resected surfaces in the humeral head.

As shown in FIGS. 6, 7A-7D and 8A-8D, the extended surface can vary inradial width W and length L. As shown in FIG. 7A-8D, the extendedsurface can be an additional modular component 80, which can be coupledto the head using varying fixation mechanisms 81. In this regard, thefixation mechanism can take the form of a pair of interference fitmembers including a male member 82 extending from the modular component80 and a female member 83 recessed within the head 12 to provide, forexample, a Morse taper lock there between. Additionally, as shown inFIGS. 8B-8D, the fixation member can be a fastener such as a screw.

As shown in FIGS. 7A-7D, the modular component 80 has an exteriorarticulating surface 84 which can have varying radii of curvature whichare congruent with the articulating surface 68. The modular component 80can also include the male member 82 and the female member 83 to providea Morse taper connection between the modular component 80 and the head12. Additionally shown is an anti-rotation member 86 in the form of apin. As shown in FIGS. 8A-8D, the additional modular components 80 caninclude a flange 85 having a through hole 91. The modular components 80can be coupled to the implant 60 by inserting the fastening mechanism 81through the hole 91 of the flange 85 and into cooperation with thethreaded bore 89. The threaded bore 89 can optionally be parallel orperpendicular to the fixation stem 64.

FIGS. 9 and 10 represent cross-sectional and exploded views of analternative prosthetic. The additional modular component 80′ is coupledto the interior coupling surface 70 via a ring lock 87. The ring 87 isconfigured to couple the annular modular component 80′ using the groove88 defined on the bearing surface 68, and a groove 90 defined on aninterior surface 92 of the modular component 80′.

FIG. 11 represents a cutting guide 98 which allows for the preparationof the humerus. In this regard, the cutting guide 98 allows for theremoval of tuberosities to make room for an extended implant. Thecutting guide 98 has a main body 100 and a cannulated handle 102. Theunderside 104 of the main body has a spherical concave surface 108 thatrelates to the spherical radius of a spherical cutter 109 used toprepare the humerus. The guide 98 is configured to be fully seated onthe resurfaced humeral head 76. A plurality of slots 106 are formedwithin the main body 100 for viewing the resurfaced head to determine ifthe guide is well seated. Additional holes 107 are formed in the guidemain body 100, which accept a plurality of guide pins 110. These pins110 prevent the rotation of the cutting guide 100 during the resectionof the humerus.

Further defined in the cutting guide main body 100 are a plurality ofangled cutting slots 112, which are configured to match the flats78A-78C created on the inner surface on the resurfacing implant. In thisregard, the angled slots 112 can form compound angles with respect toeach other. Additional groups can be formed on an exterior peripheralsurface of the main body to facilitate the removal of material. Toinsure the cutting guide is properly oriented, markings 114 can beformed on the outside surface of the cutting guide. These markings areintended to allow the relative rotation and placement of the cuttingguide with respect to predetermined or known anatomical locations, suchas the bicipital groove.

The handle 102 defines a through passage 116 or aperture, which isconfigured to slidably accept a Steinmann pin 118. It is envisioned thatthe handle can be removable from the body portion to facilitate theresection through the number of slots in the main body.

FIGS. 12-22 represent the preparation of the humerus to accept any ofthe aforementioned prosthetics. FIG. 12 represents the first step ininserting the extended articulating surface humeral resurfacing head.First, a drill guide 120 is used to locate the center of the humeralhead. The drill guide 120 has a generally spherical concave innersurface 122, which is configured to conform to the generally sphericalsurface of the humeral head. The drilling guide has a cannulated handle124, which is used to direct the placement of the Steinmann pin 118.

As shown in FIG. 12, the Steinmann pin 118 is disposed through the guideto mark the location of the center of the head. As also shown in FIG.13, a spherical surface cutter 126 is placed over the Steinmann pin andused to ream the surface of the head to remove a predetermined amount ofbiological tissue (see FIG. 14). Optionally, the reaming continues untilbone is shown coming through a plurality of holes 128 within the cutter.

The cutting guide 100, as shown in FIG. 16, is placed over the Steinmannpin 118. The cutting guide 100 is rotated so that the marking 114 on theexterior surface of the cutting guide is lined up with the bicipitalgroove. The additional guide pins 110 are then placed through the guideholes 107 in the guide to prevent relative rotation of the cutting guide100 with respect to the humerus during the resection of the humeralhead.

At this point, a rotational or reciprocal cutting tool 130 is placedwithin the cutting grooves 112 formed in the cutting guide 100. Thistool is used to form a plurality of flat surfaces 132 on the humerus. Atthis point, the anti-rotation pins and cutting guide are removed fromthe resected humerus. A spade bit 134 is placed over the Steinmann pin118 and rotated until a stop ledge 136 touches the humeral head. Boththe spade bit 134 and Steinmann pin 118 are removed from the humerus. Atrial head (see FIG. 19) is then placed onto the resurfacing bone andused to check the full range of motion and correct soft tissuetensioning. Lastly, the final prosthetic is placed onto the bone andimpacted into place.

FIGS. 20-22 represent the placement of the prosthetic 60 onto theprepared humerus. As can be seen, the exterior portion 66 is positionedto allow proper articulation of the repaired joint. A trialing head 60′is positioned to the prepared humerus. The head 60 is then coupled tothe resected humerus as previously described.

The description of the invention is merely exemplary in nature and,thus, variations that do not depart from the gist of the invention areintended to be within the scope of the invention. Such variations arenot to be regarded as a departure from the spirit and scope of theinvention.

1-20. (canceled)
 21. A modular humeral head resurfacing implantcomprising: a head including: an exterior hemispherical articulatingsurface defining a terminating rim; an interior concave surface oppositeto the exterior articulating surface; and a first coupling mechanismproximate to the terminating rim; an anchoring stem coupled to theinterior concave surface and extending along a stem axis that extendsthrough an axial center of the head; and a modular extended articulationflange axially protruding from only a portion of the terminating rim ofthe head when fastened thereto and operable to articulate with at leastone element of a coracoacromial arch and including: a second couplingmechanism configured to cooperate with the first coupling mechanism andis attached with a ring lock to the first coupling mechanism, therebyfastening the articulation flange to the head; an outer articulatingsurface that is curved along substantially its entire length and issubstantially flush and congruent with the exterior hemisphericalarticulating surface when the articulation flange is fastened to thehead; and a curved inner surface that is substantially congruent withthe interior concave surface of the head when the articulation flange isfastened to the head, wherein the extended articulation flange islocated in a lateral region of the head and extends generally parallelto the stem axis.
 22. The implant of claim 21 wherein the articulationflange is integral with an annular ring.
 23. The implant of claim 22wherein the first coupling mechanism includes an annular grooveextending around the exterior hemispherical articulating surfaceproximate to the terminating rim; and the second coupling mechanismincludes an annular recess in the annular ring; such that the ring lockthat cooperates with both the annular groove and the annular recess whenthe articulation flange is fastened to the head.
 24. The implant ofclaim 23 wherein the ring lock is flexible and includes a first end anda second end that define a space there between.
 25. The implant of claim21 wherein the articulation flange is selected from a plurality ofarticulation flanges having different lengths.
 26. The implant of claim21 wherein the first coupling mechanism includes a first anti-rotationmember and the second coupling mechanism includes a second anti-rotationmember operable to mate with the first anti-rotation member to restrictrotation between the head and the articulation flange.
 27. The implantof claim 21 wherein the implant is comprised of at least one of cobaltchrome, titanium and a biocompatible material.
 28. A modular humeralhead resurfacing implant comprising: a head including: an exteriorhemispherical articulating surface defining a terminating rim; aninterior concave surface opposite to the exterior articulating surface;and an annular groove extending around the exterior hemisphericalarticulating surface proximate to the terminating rim; an anchoring stemcoupled to the interior concave surface and extending along a stem axisthat extends through an axial center of the head; and a modular extendedarticulation flange axially protruding from only a portion of theterminating rim of the head when fastened thereto and operable toarticulate with at least one element of a coracoacromial arch andincluding: an annular ring integral with the articulation flange; anannular recess formed in the annular ring, wherein the articulationflange is fastened to the head with a ring lock that cooperates withboth the annular groove and the annular recess.
 29. The implant of claim28 wherein the articulation flange further includes an outerarticulating surface that is curved along substantially its entirelength and is substantially flush and congruent with the exteriorhemispherical articulating surface when the articulation flange isfastened to the head; and a curved inner surface that is substantiallycongruent with the interior concave surface of the head when thearticulation flange is fastened to the head, wherein the extendedarticulation flange is located in a lateral region of the head andextends generally parallel to the stem axis.
 30. The implant of claim 28wherein the ring lock is flexible and includes a first end and a secondend that define a space there between.
 31. The implant of claim 28wherein the articulation flange is selected from a plurality ofarticulation flanges having different lengths.
 32. The implant of claim28 wherein the implant is comprised of at least one of cobalt chrome,titanium and a biocompatible material.
 33. A method of resurfacing ahumeral head of an implant site, the method comprising: resurfacing thehumeral head so as to form a generally spherical surface; providing aresurfacing humeral head implant, said resurfacing humeral head implantcomprising a head including: an exterior hemispherical articulatingsurface defining a terminating rim; an interior concave surface oppositeto the exterior hemispherical articulating surface; a first couplingmechanism proximate to the terminating rim; and an anchoring stemcoupled to the interior concave surface and extending along a stem axisthat extends through an axial center of the head; selecting a modularextended articulation flange from a plurality of modular extendedarticulation flanges of different sizes, wherein said modular extendedarticulation flange includes: a second coupling mechanism configured tocooperate with the first coupling mechanism to fasten the articulationflange to the head; and an outer articulating surface that is curvedalong substantially its entire length; attaching the second couplingmechanism of the modular extended articulation flange to the firstcoupling mechanism of the head with a ring lock, such that said outerarticulating surface of the modular extended articulation flange issubstantially flush and congruent with the exterior hemisphericalarticulating surface and the modular extended articulation flangeextends axially from only a portion of the terminating rim and generallyparallel to the stem axis of the resurfacing humeral head implant; andpositioning the resurfacing humeral head implant on the resurfacedsurface of the humeral head such that the modular extended articulationflange is operable to articulate with at least one element of acoracoacromial arch.
 34. The method of claim 33 further comprisingselecting the modular extended articulation flange from a plurality ofmodular extended articulation flanges of different lengths.
 35. Themethod of claim 33 wherein the first coupling mechanism includes agroove defined in the exterior hemispherical articulating surface andthe second coupling mechanism includes an annular recess in the annularring, such that the ring lock cooperates with both the groove andannular recess when the articulation flange is fastened to the head. 36.The method of claim 35 wherein attaching the first coupling mechanism ofthe modular extended articulation flange to the second couplingmechanism includes coupling an anti-rotation member associated with themodular extended articular flange with the terminating rim of theresurfacing humeral head implant.
 37. The method of claim 36 wherein theanti-rotation member includes a pin that is received in a bore formed inthe terminating rim of the resurfacing humeral head implant.